NOTHING BUT THE TOOTH -- When is deep scaling needed?

By Dr. Richard Greenberg

Thursday

Feb 15, 2018 at 8:57 AM

Q. I am wondering if you could explain something for me. I had been searching for a new dentist. While searching, all of them said I needed a "deep scaling, under the gums." I had this procedure done 1 1/2 years ago. One dentist said they would not touch my teeth until I had it done, while another said it was against the law to clean my teeth until the deep scale was done. Possibly you could explain why the dentists all say it is necessary now to be done. I understand because of pockets, but at 56 years of age, everything changes.

A. In your case, all the dentists were starting your treatment recommending a "deep scaling," which is a specific treatment for an inflammatory situation that must be present in and around your teeth and gums. It is called periodontitis. Before prescribing treatment, I believe it is incumbent on each of the dentists you sought out to consult with you and to explain your situation in detail. What is periodontitis, what does it mean to have bone loss around your teeth and what are periodontal pockets? These pockets must be present if "deep scaling" is prescribed. Not only must they be present, but debris or accretions must have accumulated in these pockets for the treatment to be needed. This was obviously not discussed 1 1/2 years ago. "Deep scaling," more accurately described as to clean or plane or smooth the roots of your teeth, is far different then an ordinary and routine hygiene visit. If truly necessary, it will be easy for your dentist to show you the whys and why-fors.

If the inflammation caused by this debris buildup is not reversed or is left untreated, it and the bone loss it promotes can eventually cause the loss of otherwise healthy teeth.

A very important thought to keep in mind is that teeth should never be lost in anyone’s lifetime. If you are prone to periodontal disease, it can be stopped when successfully treated by the general dentist or by a specialist, the periodontist. The treatment may be much more involved and may require surgery to eliminate the periodontal pockets that accumulate debris. But it usually can be done, if your desire as a patient is to be disease-free.

Regarding your age, you must also know that it can take many years of low-grade inflammation for this disease to become evident. It can begin early on, maybe missed by the dentist or denied by you the patient. Sometimes all you notice as a patient is some bleeding and occasional tenderness that goes away on its own. Sometimes an odor or bad taste may be evident. Unless you have a rare genetic predisposition, the slow onset and not knowing the signs and symptoms can lull you into not seeking routine treatment. It is the dentist/patient relationship and discussion of it that is so important to prevent this disease from occurring and if it does how to treat.

I believe that my thoughts regarding the "deep scaling" and questions you have had should have been answered by any one of these dentists you consulted if they had taken the time to explain as I hope I have.

What happened to my crown?

Q. I needed an old crown replaced. A nice-fitting temp was created as my impression went out to be created. When the crown returned and was placed on my tooth, it kept falling off. The dentist had drilled around the tooth so much that there wasn’t enough tooth to hold the crown. An endodontist had to surgically remove gum to expose more tooth.

My question is, was the drilling overzealous or necessary? If the old one fit fine, why change the tooth?

A. I would need to know more information to give you a completely accurate answer to your excellent question. Suffice it to say that I will make some assumptions and answer based on those.

I do not know why the old crown needed to be replaced. If it was because of decay then the dentist had to drill to remove that decay and reprepare the tooth for an impression. In addition to decay removal, there are other reasons to re-prepare or drill the tooth. Assuming these preparatory steps were necessary, I would have expected that if the dentist felt there was going to be a problem retaining the new crown, he or she would have been able to tell you that and explain any additional treatment needs. That would have been a good time for you to ask about all the drilling you observed and if that had an effect on the need now for more treatment.

In your case, the dentist must have felt there was no problem with retention, as he or she went ahead and sent it to the dental laboratory for fabrication. As it turned out, that new crown did not have enough retention. It is possible that the new crown did not fit the impression properly and therefore would not fit the tooth as well. This is a laboratory error and not that on the part of the dentist. Your dentist must have felt that it was not a laboratory error but rather an error on his or her part in how the tooth was drilled or prepared. Their decision as to how to create more retention should have then been discussed with you, along with what he or she felt was their error. Taking responsibility for that would have gone a long way in allaying your concerns.

I would sum up my remarks in saying that you have a good question, should receive a good answer even now. That answer should relieve you of any anxiety over what was done and why, and if it does not, you should proceed accordingly, and in my way of thinking, seek a second opinion from another practitioner. Only at that point will you be able to evaluate the very uncomfortable situation that you were put in.

Please feel free to follow up if more pertinent information becomes available.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question? Email him at dr.richard@nothingbutthetooth.org.